July 13, 2024

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Nearly Half of Depression Patients Remain Symptom-Free After Discontinuing Medication for 12 Months

Nearly Half of Depression Patients Remain Symptom-Free After Discontinuing Medication for 12 Months



Nearly Half of Depression Patients Remain Symptom-Free After Discontinuing Medication for 12 Months

According to the World Health Organization, approximately 3.8% of the global population suffers from depression, including 5% of adults. Currently, various effective medications are available for treating depression, and more individuals are receiving treatment. Maintenance therapy can reduce the risk of relapse, but studies suggest that 35% to 60% of patients may achieve full recovery and discontinue medication after appropriate initial treatment.

How can patients safely discontinue medication? Besides the doctor’s judgment, are there additional supportive measures to facilitate positive outcomes?

A recent study published in JAMA Network Open suggests that adding online and phone support to routine doctor/nurse consultations can help improve depression symptoms, manage antidepressant discontinuation symptoms, and enhance mental health without compromising the treatment effectiveness compared to standard consultations alone.

 

Nearly Half of Depression Patients Remain Symptom-Free After Discontinuing Medication for 12 Months

 

 

The clinical trial aimed to determine the effectiveness of long-term antidepressant discontinuation strategies. It investigated whether adding online and phone support to physician assessments was safer and more effective for discontinuing medication.

Conducted in 131 community hospitals in the UK from December 1, 2018, to March 31, 2022, the study included 325 patients (average age 54.0 years; 68.6% female) who had been taking antidepressants for over a year following their first depressive episode or for more than two years due to recurrent depression. These patients were in good health, considering discontinuing medication, and had a low risk of relapse.

Patients were randomized into two groups: 178 patients in the intervention group across 66 hospitals and 147 patients in the control group across 65 hospitals, representing the current best practice.

In the intervention group, doctors/nurses not only assessed patients’ readiness to discontinue medication but also used an NHS-provided online learning platform to educate themselves and patients on tapering off medication. Additionally, patients received three phone calls with Psychological Wellbeing Practitioners (PWPs) to discuss encouragement, progress in tapering or discontinuing medication, and withdrawal symptoms. Further consultations were scheduled based on these discussions.

A total of 238 practitioners (doctors/occupational nurses) provided discontinuation assessments. Patients had immediate access to book appointments with these professionals to evaluate their ability to stop taking antidepressants. The study included a 12-month follow-up period.

The primary outcome was the severity of depressive symptoms at six months, measured using the Patient Health Questionnaire-9 (PHQ-9) score, with higher scores indicating more severe symptoms.

Analysis showed:

  • Both groups had similar average PHQ-9 scores at baseline (control: 4.3; intervention: 4.2). At six months, the intervention group showed non-inferiority to the control group, with lower PHQ-9 scores indicating milder symptoms (4.0 vs. 5.0; adjusted difference -1.1; 95% CI, -2.1 to -0.1; P=0.03). In sensitivity analysis, there was no significant difference in depressive symptoms between groups (adjusted difference -0.9; 95% CI, -1.9 to 0.1; P=0.08).
  • Secondary outcomes included antidepressant discontinuation rates, mental health, and adverse events, with the intervention group performing better overall:
    • At six months, the intervention group had a higher discontinuation rate [45.5% (66/145) vs. 41.9% (54/129)], though not statistically significant (P=0.96).
    • The intervention group experienced fewer severe symptoms and better mental health, with higher WEMWBS scores over 12 months (48.6 vs. 47.3), showing a statistically significant difference.
    • Fewer severe adverse events were reported in the intervention group (2 patients) compared to the control group (5 patients, with 4 experiencing 2 events each; P=0.15).

Although the discontinuation rate did not significantly improve, the study found that routine doctor/nurse consultations for discontinuation are safe and effective for over 40% of patients who meet the criteria and wish to stop medication. Adding online and phone support can offer additional benefits.

The research team emphasized the need for proactive assessments by doctors regarding antidepressant discontinuation and called for more studies to provide further information on the benefits and risks of relapse, encouraging doctors and patients to attempt discontinuation when appropriate.

Professor Mark Gabbay from the University of Liverpool, a co-author of the study, stated, “The research shows that many patients do not need intensive face-to-face therapy during discontinuation.” He added, “This is the first study to explore stopping long-term antidepressant treatment without the need for psychological therapy.”

Nearly Half of Depression Patients Remain Symptom-Free After Discontinuing Medication for 12 Months


(source:internet, reference only)

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